Nothing's sleepy about M&A in the anesthesia sector

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

IkeBoy18

Full Member
15+ Year Member
Joined
Jul 13, 2005
Messages
720
Reaction score
105
seeing that I would like to go home to Houston to practice eventually, Im not sure if its just bad or really bad that that AMCs will completely own the area.

http://www.thedeal.com/content/healthcare/nothings-sleepy-about-ma-in-the-anesthesia-sector.php

As private equity-backed Continental Anesthesia Ltd. attempts to expand its roster of physicians to 150 in the coming months, it finds itself in a sector where larger medical services consolidators, such as MedNax Corp., are on the prowl for buyout candidates.

"The anesthesia space is consolidating rapidly and I think that any company with a strong relationship with payers and hospitals is a real candidate for MedNax and others in the space," said Dougherty & Co. LLC analyst, Brooks O'Neil, who covers the healthcare space.

Continental, whose official corporate name is TBG Anesthesia Holdings Inc., was purchased by New York PE firm Beekman Group LLC in 2009 for undisclosed terms. The company has since grown into a regional powerhouse in the Chicago area, with 100 physicians serving 20 hospitals and ambulatory surgery centers in the Midwest.

Continental disclosed in an Oct. 11 press release that is was looking to expand its practice to 150 physicians within the next few months, but didn't say whether that growth would be organic or through M&A. O'Neil explains that the anesthesia space has been rife with deal activity of late as investors try to take advantage of the "graying of America."

Both Mednax and rival healthcare services company Team Health Holdings Corp. have been actively acquiring smaller practices to gain market share and geographic reach.

Mednax and others like it "saw the opportunity to bring specific expertise to a highly specific group of customers," O'Neil explained. "In the anesthesia space in particular, you need anesthesia for surgeries and with the overall population aging, it's is a smart move to get into this space."

Mednax alone has completed several acquisitions of anesthesia practices around the country this year, with its most recent being the Sept. 11 deal for Northern Westchester Anesthesia Services PC, a physician group practice based in Mount Kisco, N.Y.

Terms of the deal were not disclosed, but Fort Lauderdale, Fla.-based Mednax said it paid cash for the target, which employs 16 anesthesiologists and nine anesthetists.

Other Mednax deals include the May 1 acquisition of Gwinnett Anesthesia Service PC of Lawrenceville, Ga., the May 30 purchase of Anesthesia Specialists of Houston LLP and the Jan. 1 deal for South Oakland Anesthesia Associates. Terms weren't disclosed for any of them.

Knoxville, Tenn.-based TeamHealth, meanwhile, has also been rolling up the sector, inking its most recent acquisition on Nov. 12 by buying Wolverine Anesthesia Consultants Inc. for undisclosed terms.

Other strategic buyers are out there, too, such as Envision Healthcare, a former portfolio company of Clayton, Dubilier & Rice LLC that was spun off in 2013.

PE firms continue to hover over the sector, too. "There are at least four or five private equity firms that have [asked] me about taking advantage of the [anesthesia] space," said Jeff Swearingen, co-founder of Edgemont Capital Partners LP, a New York investment bank focused on healthcare companies that worked with South Oakland on its sale to Mednax and Wolverine on its sale to Team Health.

As Swearingen noted, there's a dichotomy among buyers. There are Team Health and Mednax, "which have multiple physician specialties" and "are focusing on -- for lack of a better term -- becoming one-stop shops for healthcare services," he explained. But there are also "those PE-backed companies that are looking to consolidate and seem to focus just on the anesthesia space," he added.

Swearingen declined to say whether he believed Oak Brook, Ill.-based Continental fit in either category.

Certainly, other 100-physician anesthesia practices are falling into the arms of PE buyers. TPG Capital LP on Oct. 10 completed a platform acquisition of Arlington, Texas-based NorthStar Anesthesia, a 100-physician practice, for undisclosed terms.

Mednax has gone after even-larger prey, such as Anesthesia Specialists of Houston, with its 650 physicians and 950 anesthetists under management.

"I think any practice is a candidate for a roll up," said Amanda Jester, an M&A attorney at Nashville law firm Waller Lansden Dortch & Davis LLP who also advised Orlando, Fla.-based Wolverine on its sale to Team Health. "In terms of how many physicians are in the practice ... I've done deals with practices with anywhere from 2 to 150 physicians."

She said a practice's vulnerability to a buyout "just really depends on a case-by-case basis. Some of it is geographic and [depends on] where their competitors [are] in that market."

Jester noted that scale and size are important, but both factors pale in comparison to the importance of a practice's relationship with the hospitals and other healthcare centers it serves.

Continental, with relationships with more than 20 hospitals, didn't respond to calls. Beekman officials declined comment. One interesting thing about the PE firm: It has yet to make a bolt-on acquisition for Continental since buying it four years ago.



Read more: Nothing's sleepy about M&A in the anesthesia sector - The Deal Pipeline (SAMPLE CONTENT: NEED AN ID?) http://www.thedeal.com/content/heal...ma-in-the-anesthesia-sector.php#ixzz2owm6Mxxd

Members don't see this ad.
 
Members don't see this ad :)
Dont take a long partnership track gig.

Some private practices will survive. Those that do will be highly sought after. Choosing a long partnership track job is a high risk high reward strategy.

We know that employment is coming for us.
 
"Anesthesia Specialists of Houston, with its 650 physicians and 950 anesthetists under management"??? Somebody isn't doing their homework. Correct me if I'm wrong, but ASH was a relatively small group that is now part of American Anesthesiology, and THAT company might have that many providers. No way ASH does. Even prior to their acquisition by a PE firm, GHA wasn't even close to those numbers.
 
"Anesthesia Specialists of Houston, with its 650 physicians and 950 anesthetists under management"??? Somebody isn't doing their homework. Correct me if I'm wrong, but ASH was a relatively small group that is now part of American Anesthesiology, and THAT company might have that many providers. No way ASH does. Even prior to their acquisition by a PE firm, GHA wasn't even close to those numbers.
I was about to say the same thing. GHA (now part of USAP) basically runs Houston, and they aren't that big. Makes you wonder about the rest of the figures in the article, although you still cannot dismiss its point.
 
Some private practices will survive. Those that do will be highly sought after. Choosing a long partnership track job is a high risk high reward strategy.

We know that employment is coming for us.

Yep. In the long term if 90% of private practices are part of AMCs, the 10% that aren't will be highly desirable to work in but will be very hard to get jobs with.
 
Yep. In the long term if 90% of private practices are part of AMCs, the 10% that aren't will be highly desirable to work in but will be very hard to get jobs with.

And if recruiting isn't hard be prepared to be ****ed and never be able to be an equal partner. Just because it's a private practice doesn't mean you'll be included. You won't. The recent history of anesthesia shows your 'collegues' are more than happy to rob you if they can get away with it. In a tight market they can get away with it.

The partial ownership of a private equity-owned practice may be the best option in the near future aka the future isn't bright in anesthesia- unless you think being a replaceable employee is a nice future.
 
Last edited:
And if recruiting isn't hard be prepared to be ****** and never be able to be an equal partner. Just because it's a private practice doesn't mean you'll be included. You won't. The recent history of anesthesia shows your 'collegues' are more than happy to rob you if they can get away with it. In a tight market they can get away with it.

The partial ownership of a private equity-owned practice may be the best option in the near future aka the future isn't bright in anesthesia- unless you think being a replaceable employee is a nice future.

This problem/concept isn't limited to anesthesia. Many hospitals are buying up physician practices in any number of specialties. In some hospitals, the entire medical staff is either an employee of the hospital or an employee of the medical group owned by the hospital. It also applies to management companies as well. American Anesthesiology is a division of Mednax, which also has a large pediatric/neonatal/MFM division. ApolloMD started with EM, but has expanded into anesthesiology, radiology, and hospitalists.
 
This problem/concept isn't limited to anesthesia. Many hospitals are buying up physician practices in any number of specialties. In some hospitals, the entire medical staff is either an employee of the hospital or an employee of the medical group owned by the hospital. It also applies to management companies as well. American Anesthesiology is a division of Mednax, which also has a large pediatric/neonatal/MFM division. ApolloMD started with EM, but has expanded into anesthesiology, radiology, and hospitalists.

True but most specialties aren't hospital-based, so they don't HAVE to have a middle man taking their income or making employment decisions about them.

Don't get me wrong, I don't want to run an office full of bickering staff and those hassles. I just want a true partnership job, and it sucks that the current generation have destroyed private practice anesthesia. ****ers.

I write this on lots of threads cause I feel like b****ing, but I also want med students to know that the anesthesiology they see isn't the anesthesiology they'll find when they start working.
 
Last edited:
True but most specialties aren't hospital-based, so they don't HAVE to have a middle man taking their income or making employment decisions about them.

Don't get me wrong, I don't want to run an office full of bickering staff and those hassles. I just want a true partnership job, and it sucks that the current generation have destroyed private practice anesthesia. *******.

I write this on lots of threads cause I feel like bitching, but I also want med students to know that the anesthesiology they see isn't the anesthesiology they'll find when they start working.

Med student here, and it is depressing to read this expressed on different forums and blogs in various ways. I have not enjoyed any other part of medicine and it sucks that what I will be doing wont even resemble what I love at the moment. As a matter of fact I hated most all the rest of them. Maybe I hate some other specialty just under the threshold of not being able to endure it for 30 yrs.
 
Top